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Introduction / objectives

Ventilator-associated pneumonias (VAP) are the most prevalent infections in intensive
care units (ICU). To reduce this rate, it is recommended the application of bundles
- groups of individual practices that result in substantial improved care.

Aim

To measure the adherence to VAP bundle, correlating with the incidence of VAP per
1000 days of mechanical ventilation (MV).

Methods

The study was conductedin three general ICU (adult, cardiology and pediatric) of a
medium sized hospital in Sao Paulo (Brazil) from June/2009 to April/2010. All patients
on MV were assessed using a check list with five key measures: physiotherapy, presence
of condensate in the circuit, a high head>30°, oral hygiene with chlorhexidine and
manual resuscitator individual. The visits were carried out fortnightly, without notice,
by the same researcher, with subsequent calculation of compliance.

Results

At the beginning, the incidence of VAP was 20/1000 days of MV and the adherence to
the measures was 15%. In the second month, the membership had increased gradually,
inversely proportional to the rate of VAP. From September to December, adherence ranged
from 40 to 70%, with rates of VAP from 5 to 15/1000 days of MV. In February, there
was a peak (30/1000 days of MV) and good adhesion to the bundle (70%), which may reflect
the increase of patient severity. Later, the Infection Control Team developed an educational
work, resulting in significant decrease in VAP rate (8/1000 days of MV) and 90% adherence
to the bundle.

Conclusion

The application bundle is a feasible reality that produces good results in nosocomial
infection rates. However, education and periodic training remain a fundamental process
of improving health services.